Insulin Glargine, rDNA Origin
Brand Names: Basaglar, Lantus, Toujeo
Injection (Lantus): 100 units/mL in 10 mL vials, 3 mL SoloStar pens
Injection (Toujeo): 300 units/mL in 1.5 mL SoloStar pens
Injection (Basaglar): 100 units/mL in 3 mL Kwikpen delivery device
Indicated for once-daily subcutaneous administration at bedtime in the treatment of adult and pediatric patients with type 1 diabetes mellitus or adult patients with type 2 diabetes mellitus who require basal (long-acting) insulin for the control of hyperglycemia: Dosage must be individualized. Patients with type 2 diabetes who have not used insulin before should be started on 10 units per day. If changing from a treatment regimen with an intermediate- or long-acting insulin, the amount and timing of any short- or fast-acting insulin analog or the dose of any oral antidiabetic drug may need to be adjusted. Blood glucose monitoring is recommended for all patients with diabetes mellitus.
Pharmacology/Pharmacokinetics:
Insulin is the primary hormone responsible for carrying out proper glucose utilization in metabolic processes. In adipose and muscle tissue, insulin activates specific enzymes, promotes the transport of monosaccharides (including glucose) across cell membranes, and facilitates the transformation of intracellular amino acids into proteins. Insulin glargine is a recombinant human insulin analog that is long-acting (up to 24 hours). Insulin glargine differs from human insulin in that the amino acid asparagine at position A21 is replaced by glycine and two arginine are added to the C-terminus of the B-chain. Insulin glargine has a low aqueous solubility at neutral pH. At the injection solution pH of 4.0, insulin glargine is completely in solution. Upon injection, the pH is neutralized and the insulin glargine precipitates from which small amounts of insulin are released over time.
Drug Interactions:
The following drugs may decrease the hypoglycemic effects of insulin detemir: corticosteroids, diltiazem, dobutamine, epinephrine and other sympathomimetic agents, oral contraceptives, thiazide diuretics, thyroid hormones, and tobacco smoke. The following drugs may increase the hypoglycemic effect of insulin detemir: Alcohol, anabolic steroids, nonselective beta-blockers, clofibrate, fenfluramine, guanethidine, MAO inhibitors, phenylbutazone, salicylates, sulfinpyrazone, and tetracyclines.
Contraindications/Precautions:
Insulin dosage is very individualized and small changes in dose, syringe brand or size, or insulin brand may necessitate the need for an adjustment of dose. Hypoglycemic reactions are not uncommon in diabetics and may be caused by excessive insulin dose or when glucose absorption is decreased due to fasting, diarrhea, or vomiting. Hypoglycemia may be differentiated from ketoacidosis not only by lab tests but by its symptoms. Symptoms of hypoglycemia include sudden onset, sweating, headache, dizziness, confusion, shakiness, slurred speech, hunger, and a rapid pulse. Symptoms of ketoacidosis include polydipsia, polyuria, drowsiness, anorexia, breathing difficulty, fruity-smelling breath, and nausea or vomiting. Hypoglycemia may be treated with glucose tablets, orange juice, or hard candy. Insulin glargine is not intended for intravenous administration. The prolonged duration of action of insulin glargine is dependent on subcutaneous administration. Pregnancy Category C.
Adverse Effects:
Pain at the injection site is slightly more prevalent with insulin glargine versus NPH human insulin although it is usually mild and does not result in discontinuation of therapy. Allergic reactions are rare and may include rash, edema, pruritus, bronchospasm, hypotension, or shock. As with any insulin, hypoglycemic reactions may be associated with administration of insulin glargine.
Follow prescribed diet closely.
Do not change insulin brands, syringe brands, or dose without first notifying a physician.
Consult a physician during any illness.
Do not dilute or mix insulin glargine with any other insulin or solution.
Insulin glargine should be clear and colorless with no particles visible.
Unopened vials should be stored in the refrigerator (36°F-46°F). Do not freeze. Insulin glargine can be kept at room temperature (<86°F) for 28 days. Opened vials should be discarded after 28 days.
Wear or carry diabetes identification in case of emergencies.
Continually monitor blood or urine glucose as prescribed.
If a dose is missed, take it as soon as possible.
Patients should be aware of the signs of hypoglycemia including sweating, tremor, blurred vision, weakness, hunger, and confusion. When two or more of these effects are seen, treat with oral glucose or contact a physician.